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C— "d 1 N <br /> a) NW <br /> O O0 Cn Ul <br /> D O rQZ <br /> G) <br /> sv cfl Z <br /> M' <br /> � m <br /> IT CD CD <br /> U) Q <br /> O <br /> zpq., I: i.577 AF,. w day, O <br /> Vzii <br /> Y <br /> rMlRl,al •-. Marar Raa�mlaalamw dun awwnn oeenx,�s <br /> ' G'^e^Mars Ryorle. '� <br /> s Xnrmaa�t <br /> v w ne <br /> VKAj.�'.•�:.a^_.n:'.- US EPa ID Numhar <br /> 7, <br /> �`Mj_���FMS u.5 EPA IC N�m<�er <br /> a acyl Q <br /> IT'S A+M^fA':{fAr` Aatlrr:., <br /> ��t ' •l, N7 US EPR 1➢Numon O <br /> +tAAA <br /> F 's Mmrpe <br /> P <br /> NHUb P <br /> HMIm.Was,g roper Shipping Nama.H-11 Glass.IO Num1r. le.Contarner5 W <br /> sror,o!a aeyn n Tom 2.unu a waew conte O <br /> O 1 No Type Qu-bty W!Not N <br /> N <br /> N <br /> 2 C.ti <br /> a.1 <br /> O <br /> r--r <br /> J <br /> 74 Addlfionai Ir.k]rmd110n r-r <br /> r--r <br /> 13. GENERATOR'S10FFEROR'S CERTIFICATION:i hereby declare Mal the contents of thrs wnsignmant are fogy and accwaiely described above by me omper sh,,q name,am are dass�ed.➢ackaged, <br /> marked and labeledPfacarded,and are in all respects in Proper wnditwn for transport according to apPlicable illtsmandrlBl and national opvemmental regulations.eexpor4 strpmenl and i am the P—hy <br /> Exporter,I certify Ihal Me wnlenls of this nwrsignmenf wirfawm to the terms of the attached EPAAcknowladgnoO of Consent, <br /> I cartHy mar the waste minimi'mhon sratemenl Aentlfied in 40 CFR 262.27(a){if!am a large quantity generator)or(b)(d l am a small quanflty pirarator)!s true. <br /> C,eneraforslt7s<emr's Prinlco'fyped Name Signature Month Day Year <br /> .� 16 mlamarranat Shlpmems <br /> F ❑Impart to U.S. &port from LLS, Port of entrylesiC <br /> = Transporter signature(for exports only) Date leaving IJ S.: <br /> W17 TranspatierAckrwwledgmenf ar RecelpldMaterials <br /> Transporter I Pnnred/Typed Name Signature Month Day Year <br /> Si nature Month Day Year <br /> C <br /> Tarrsppier 2 Pnn yped Name 9 <br /> 16 Dwaepancy <br /> 18a Dkx#pahcy lrldtcabor Space ❑Qcardlly ❑Tvpe ❑Residue ❑Partial Rejedon ❑FuH Reyec1ton <br /> Manifest Reference Number <br /> (a Generator) U.S.EPA ID Number <br /> L, <br /> Month Day Year <br /> (or Generator) <br /> O (D <br /> I Method Codes{i e.,Codes for hazardous waste treatment,disposal,and recyding systems) c.Q n <br /> � O <br /> 2, 3. 4 <br /> CerbWboh of recelpl of hazardous materials covered by the manifest except as nded in Item 18a = <br /> Month 4ay Year <br /> Signature <br /> CD <br /> Cn <br /> v <br /> �e>�solete. GENERATOR'S 1KtT1At COPY <br /> N <br /> 00 <br /> � W <br /> O <br /> Cn <br /> Cn <br />